cervical radiculopathy

[gcoe]

like trigger point....since the pt is getting symptoms in palm and also there is radiation component present ,i doubt it could be becoz of trigger point??

Trigger points follow non dermatomal patterns. And then there is the satellite phenomenon where a more proximal muscle will invoke myofascial symptoms more distally Have a look at my commnet about the scalenes below re: distribution of symptoms into the hand. So you have to actually check for trigger points. It seems you haven't done this.

u mentioned to check with dermatome!!!clinically and subjectively pt has c5,c6,c7 and c8 dermatome involvement mainly parasthetias.

That is a very extensive dermatome distribution. If it was a radiculopathy it should really match one segment. Possibley it could be more dital BP involvement, or pseudo-neural symptoms from ANS or trigger points. And you haven't really answered my question about objective signs - you need to do sensory testing to try to sort this through.

as I have mentioned in previous note pt has severe degenerative changes in cx spine x ray so how much we can go with cx mobi?

I think this is a pertinent point. However basing a decision on plain xray is not a solid foundation for cause-effect thinking. All the xray is telling you is that here are signs of severe degeneration - doesn't indicate that the symptoms are necessarily due to one of the patho-physiological processes underlying the degeneration (osteophytes, spondylosis episode etc). The relationship between visible degeneration and severity of symptoms is notoriously unreliable. As you achieved a temporary but effective-at-the time improvement in symptoms isn't that what you should be proceeding with first? You haven't answered my question about whether it was lateral glides or BP mobs that relieved her symptoms. You really have to go back and look at this.

pt gets tingling with neck isometric contractions??i tried with towel exr....when i tried with pressure feed back with mild contractions so symptoms but with vigorous contractions she gets the same????

Do you mean she gets NO symptoms on mild contractions? I am not sure if this is really going to be very instructive. The onset of symptoms could be due to:
* contracting the muscles around the course of the brachial plexus thereby increasing adverse neural tension - but that doesn't tell you where
* compressive force generated on the offending cervical mobility segment thereby increasing encroachment of the spinal nerve
* flexion movement of the cervical spine or a combination of movement + compression. Again not very instructive.
* active contraction of of para cervical muscles that have trigger points. For example the scalenes produce symptoms into the lateral forearm thumb and forefinger and back of hand. If your patient has trigger points.

I think your thinking has become clouded and you have to go back to a getting a clear diagnosis.Giving her exs of whatever sort at this stage means you are just working in the dark. In the long term ex's may be warranted but you have to have a clear reason for doing them. On the positive side you have effected a significant but temporary improvement so this gives you a lead in your diagnosis.

[sharadphysio]

hi! thanks for ur second reply to my counter queries
ur suggestions
1)trigger pts
yes ..u r absolutely right..that trigger point refer pain in non dermatomal pattern.as far as i know neck muscles like trep.,suboccipital ,levator scapulae etc.-have referral pattern in arm max till elbow.From ur response i came to know about scalane referral area which is in hand and forearm.my pt had trigger point in trep.so with local pressure on trigger point,the pain used to get referred in distal arm,after treating the triger point,the severity of paresthetias has been reduced but not completely abolished.still pt get paresthetias in dorsal hand and fore arm(as per ur advice i wil certainly check for trigger point in scalenae which i have not checked yet)
i also would like to know the muscles(trigger point) which refer pain in distal hand and fore arm.

2)secondly,objective signs
pt does not have significant positive objective finding which is a bit confusing me.pt's neuromeningeal extensibility was reduced initially,now with neu. tissue mobi. the frequency of paresthetias in hand and fore arm has been reduced but again not completely abolished.(i have seen gradual improvement with addition of components of neu.tissue mobi.)so it gives the answer for one of ur query which says whether neu.tissue mobi has affected the symtoms or not.yeah...but i am not sure about cx lateral glide which i applied during the course of treatment...so i m not sure about lat glide effectivity.

3)one more thing ....according to u which cx mobilization is effective for radiculopathy cases
i mean whether cx lat glide or unilateral post ant mobili. or plain post ant mobi
since in this particular case what i found with passive physiological movt test of cx spine-post ant mobility ,unilateral post ant mobility and cx lateral glides........were significantly reduced....any experience with this issue???

thanx